Provider Demographics
NPI:1275820029
Name:CLEWELL, DANIEL J (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:CLEWELL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 BRYONAIRE RD
Mailing Address - Street 2:APT.B
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-9111
Mailing Address - Country:US
Mailing Address - Phone:740-705-2393
Mailing Address - Fax:
Practice Address - Street 1:355 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:44904-1336
Practice Address - Country:US
Practice Address - Phone:419-884-6107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03230510183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist